A look at how other developed countries provide and pay for health care compared with the U.S. system, based on the most recent information available:
The U.S. health care system operates through a combination of public and private insurers. Two of the largest government-run insurance programs are Medicaid and Medicare, which are funded by income taxes and available to low-income citizens and the elderly. Those not in government-run programs must find coverage through the private market, from their employer or go uninsured. Care is largely provided by private doctors at private facilities.
Germany requires people making less than about $70,000 a year to have health insurance, which is operated by more than 200 competing, non-profit insurance companies. Those making more than $70,000 a year have the option to be under the mandatory health care, or they can buy private insurance or go uninsured. The system is funded through an income tax. Care is provided by private doctors and a mix of private and public hospitals.
Sweden provides universal health care coverage. The program is funded through central and local taxes and co-payments on services. The national government regulates the system, but the local governments organize the care facilities. Doctors can be government employees or private practitioners because the local governments can decide what system is best for their community. In most cases, hospitals are owned and operated by the local government.
Canada provides universal health care; however, many Canadians purchase insurance to supplement the government program. The program is funded through general taxation, and any supplemental insurance is paid out-of-pocket. The majority of doctors are not employed by the government. Hospitals can be either public or private, but their budgets are negotiated with the government.
Italy offers health care to all residents. Funding for the health care system comes from a mix of income taxes, local taxes and co-payments. Care is delivered through private doctors. Most hospitals are government-run. There are some private and for-profit hospitals.
Spain provides universal health care coverage; however, a small portion of the population purchases supplemental health insurance. The funding comes from taxes and out-of-pocket payments. The national government decides the direction of the system, while the local governments determine how the care is delivered. Doctors are private practitioners, and the majority of hospital beds are government-owned.
Australia provides health care to citizens, permanent legal residents and visitors from certain countries. The care is funded by an income tax and rebates to a supplemental insurance program. Care is provided by private doctors. Public hospitals provide free care, while private hospitals tend to cater to people with private insurance.
Everyone living or working in the Netherlands is required to purchase health insurance. Insurers are required to offer a government-mandated standard package and provide coverage to all. The government gives subsidies to companies that take on high-risk clients with chronic illnesses and severe disabilities. Minors, the unemployed, the elderly and people who are not able to pay for insurance are covered through a government fund, which is paid for through income taxes. Care is provided through private doctors and care facilities.
The U.K. offers health care to all people "ordinarily resident" in the country. Most services are free or available with a small co-payment. The main source of funding is general taxation. Doctors and hospitals are generally employed and operated by the government; however, there are private practitioners who may or may not be reimbursed by the government.
France provides health care for all living in the country — legally and illegally. The main source of funding is payroll and income taxes; however, the government implements some cost-sharing techniques, including co-payments and extra billing. Care is provided by private doctors, even though the majority of hospitals are owned by the government.
Sources: McKinsey; The Commonwealth Fund; Organization for Economic Cooperation and Development; Central Intelligence Agency; The Harris Poll; Spanish Ministry of Health and Consumer Affairs
1—estimate; 2—2007; 3—2006;
**—2002 Sources: McKinsey; The Commonwealth Fund; Organization for Economic Cooperation and Development; Central Intelligence Agency; The Harris Poll; Spanish Ministry of Health and Consumer Affairs